Introduction: In recent years, endoscopy has gained tremendous popularity among skull-base surgeons as a minimally invasive technique. However, the majority of its use has been via endonasal and intraventricular approaches. Few authors have described fully endoscopic techniques to the CPA and no large series of vestibular nerve sections (VNS) have been reported in a fully endoscopic manner. We describe our experience and results, including technical details, of our experience performing VNS with a fully endoscopic technique.
Methods: Between 2006 and 2013, 41 patients underwent VNS in a fully endoscopic technique at our institution for medically-refractory Meniere’s Disease. A 14 mm retrosigmoidal craniectomy was utilized and the operative microscope was not used at any point. We report our results in terms of symptom improvement and describe our operative technique. Hearing preservation is reported based on the Gardner-Robinson (GR) score, while facial nerve preservation is reported with the House-Brackman (HB) score. Peri-operative data is also included.
Results: Mean age at the time of surgery was 50.1 years and patients had a minimum of one-year follow up. Symptoms improved or resolved in 38 of 41 (92.2%) of patients with only 1 of 41 (2.4%) demonstrating worsening of symptoms. All 41 patients (100%) had a post-operative HB score of 1/6, demonstrating full facial nerve preservation. Hearing was stable or improved in 34 of 41 (82.9%) patients. Three complications took place for a rate of 7.3%, one CSF leak and two infections. Mean operative time was 114.0 minutes with a mean estimated blood loss of 22.3 mL. Mean length of hospital stay was 3.7 days with a range of 2-7 days.
Conclusions: The fully endoscopic approach to vestibular nerve sections is a safe and effective technique. Excellent results are possible to smaller incisions, minimal cranial opening and no cerebellar retraction with improved visualization of the CPA neuro-vascular structures.
Patient Care: By providing insight into CPA endoscopy.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the improvements of Endoscopy in the CPA
2) Understand the basic endoscopic operative approach to the CPA
3) Have a better appreciation of endoscopic visualization